Controlled Trial of Captopril in Chronic Heart Failure: A Rest and Exercise Hemodynamic Study
Controlled Trial of Captopril in Chronic Heart Failure: A Rest and Exercise Hemodynamic Study
复制标题
卡托普利治疗慢性心力衰竭的对照试验：休息和运动血流动力学研究
作者：
B. Kramer;B. Massie;N. Topić
虽然许多研究表明，急性血液动力学改善充血性心力衰竭患者治疗血管扩张药物，长期对照研究与血液动力学和运动能力的测量是不可用的。我们研究了16例纽约心脏协会功能分级为II-IV级心力衰竭的非卧床患者的转换酶抑制剂卡托普利，这些患者在地高辛和利尿剂治疗后临床稳定。通过血池造影、静息和运动时的右心导管插入术以及运动能力的测量来量化对开放标签的卡托普利的急性反应。然后，患者被随机分配到维持治疗与卡托普利或匹配的安慰剂，并重新研究3个月后。两组患者的临床特征、治疗前静息和运动血流动力学指标相似。静息状态下，两组患者对卡托普利的急性有益反应相似，左室充盈压平均从24.9降至14.6 mm Hg心脏指数从2.1 ± 0.5增加到2.5 ± 0.61/min/m2（p <0.01），中风指数从25 ± 8增加到34 ± 8 mI/M2（p < 0.001）。运动过程中血流动力学改善方向相似，3个月后，这些有益的血流动力学变化仅在随机分配至卡托普利组的患者中持续存在。与此同时，开搏通组患者的自行车运动持续时间（9.0 ± 2.2 vs 11.7 ± 1.4 min，P < 0.01）、最大运动负荷（360 ± 80 vs 460 ± 50 kpm/min，P < 0.005）和氧耗量（12.9 ± 2.3 vs 15 ± 1.8 ml/kg/min）均增加。安慰剂组在3个月内与治疗前测量值相比没有变化或恶化，这些结果表明，卡托普利是治疗慢性心力衰竭的有效药物，它产生长期的血流动力学改善以及运动能力的增加。
Although many studies have shown acute hemodynamic improvement in patients with congestive heart failure treated with vasodilating drugs, long-term controlled studies with both hemodynamic and exercise capacity measurements are not available. We studied the converting-enzyme inhibitor captopril in 16 ambulatory patients in New York Heart Association functional class II-IV heart failure who were clinically stable on digoxin and diuretics. The acute response to open-label captopril was quantified by blood pool scintigraphy, right-heart catheterization at rest and during exercise, and measurements of exercise capacity. The patients were then randomized to maintenance therapy with captopril or matching placebo and were restudied after 3 months. The two groups were similar in their clinical characteristics and pretreatment rest and exercise hemodynamic measurements. Both displayed similar acute beneficial responses to captopril at rest, with a mean reduction in left ventricular filling pressure from 24 9 to 14 6 mm Hg (p < 0.001) and increases in cardiac index, from 2.1 0.5 to 2.5 + 0.61/min/m2 (p < 0.01), and stroke index, from 25 8 to 34 + 8 mI/M2 (p < 0.001). Directionally similar hemodynamic improvement was noted during exercise.After 3 months, these beneficial hemodynamic changes were sustained only in the patients randomized to captopril. Concomitantly, the captopril patients increased their exercise capacity as measured by the duration of bicycle exercise (9.0 2.2 vs 11.7 1.4 min, p < 0.01), maximal work load (360 80 vs 460 50 kpm/min, p < 0.005) and oxygen consumption (12.9 2.3 vs 15 + 1.8 ml/kg/min). The placebo group showed either no change or a worsening over the 3 months compared to their pretreatment measurements.These findings demonstrate that captopril is an effective adjunctive agent for the treatment of chronic heart failure and that it produces long-term hemodynamic improvement together with an increase in exercise capacity.
对比硝酸异山梨酯对充血性心力衰竭运动能力的近期和长期影响。
DOI：
10.1016/0002-9343(80)90468-4
发表时间：
1980
期刊：
The American journal of medicine
影响因子：
--
作者：
Franciosa,JA;Goldsmith,SR;Cohn,JN
通讯作者：
Cohn,JN
血管扩张剂耐受性治疗充血性心力衰竭的机制和意义。
DOI：
10.1016/0002-9343(81)90263-1
发表时间：
1981
期刊：
The American journal of medicine
影响因子：
--
作者：
Colucci,WS;Williams,GH;Alexander,RW;Braunwald,E
通讯作者：
Braunwald,E